Biomedical Research

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Abstract

During daily training, shot putters are prone to acute complete anterior cruciate ligament injury, which is mainly treated with early reconstruction under knee arthroscopy to restore stability of injured athletes’ knee as soon as possible, help them towards early recovery and resume normal work and training. During knee arthroscopic treatment, extrusion screws are mainly used for acute complete anterior cruciate ligament injury patients to fix bone- patellar tendon (1/3)-bone complexus autotransplantation, reconstruct anterior cruciate ligament, conduct stop reconstruction or suture medial collateral ligament. During 2006 and 2015, 3000 cases of patients with acute complete anterior cruciate ligament rupture and medial collateral ligament rupture were treated with an average followup of 1 year, incision healed well and no infection was found and the patient recovered well after operation. As can be seen from this retrospective analysis, under arthroscopy, reconstruction of acute complete anterior cruciate ligament injury can be performed. The outstanding advantages of this treatment are small surgical trauma, timely treatment and good effect. Early arthroscopic reconstruction of ACL can clear intra-articular injury, shorten the treatment process, and meet the standard of treatment specification. It is worthy to be promoted in clinical application.

Keywords

Introduction

An anterior cruciate ligament (ACL) tear is a serious knee
injury with a high risk of morbidity in the young and active
population [1]. Shot putters’ acute anterior cruciate ligament
rupture is a very serious sports injury. This damage is with
relatively high violence, which is often combined with injury
of other structures [2]. After the injury, if athletes cannot
receive timely and accurate diagnosis and therapeutic
treatment, the best time for treatment of acute complete
anterior cruciate ligament injury will be adversely affected,
bringing a series of complications, possibly secondary knee
instability, which seriously affects patient's knee joint function,
or even leads to a series of knee sequelae lesions. The ACLinjured
knee has an associated meniscus injury at primary ACL
reconstruction (ACLR) in .40% of patients [3]. An ACL injury
is a strong risk factor for osteoarthritis, and a concomitant
meniscus tear significantly increases that risk [4,5]. Some
researchers showed that anterior cruciate ligament injury
delayed more than 3 months without surgery, which could
result in secondary injuries such as meniscus, articular
cartilage and traumatic arthritis [6-8]. In long course of
treatment, conventional knee joint damage is commonly treated
with surgery, the basic method of which is incision. However,
such surgery process is very complex with great trauma.
Postoperative recovery rate and postoperative rehabilitation of
patients are very slow, which will cause serious adverse effects
on career of athletes engaged in competitive sports as a
profession [9]. Anterior cruciate ligament injury is a common
training injury. With the development of arthroscopic
technology, the open end surgery has been abandoned.
Arthroscopic reconstruction of the ligament has become the
gold standard for treatment [10,11]. Thus, early minimally
invasive surgery for acute complete anterior cruciate ligament
injury is the main focus of clinical research. The purpose was
to determine the clinical effect of arthroscopic treatment for
ACL reconstruction. This paper summarizes clinical study of
early reconstruction of acute complete anterior cruciate
ligament injury under knee arthroscopy. During 2006 and
2015, 3,000 patients were treated, who have good clinical
rehabilitation recently, so certain clinical research
achievements have been achieved. Now, the feelings and
experiences will be summarized below.

Materials and Methods

General information

During 2006 and 2015, 3000 cases of patients with acute
complete anterior cruciate ligament were treated, including
1800 cases of male patients, 1200 cases of female patients; the
patients were aged between 16 to 25 years, with mean age at
(18.32 ± 2.08) years old. There were 1200 cases with left knee
anterior cruciate ligament injury and 1800 cases with right knee anterior cruciate ligament injury. The inclusion criteria
and exclusion criteria refer to the literature [1]. This research
was approved by the Ethical Committee of Hunan Mechanical
and Electrical Polytechnic according to the declaration of
Helsinki promulgated in 1964 as amended in 1996, the
approval number is 2006001. All the patients enrolled in the
study are exercise-induced injury patients, of which, 2800
patients were professional shot putters, 200 patients were
accidentally injured during shot activities. The period from
injury to operation time lasted 1-11 days, averagely (5.32 ±
1.82) days. For combined injury, there were 1200 cases of
complete rupture of medial collateral ligament, 1300 cases of
transverse tear of medial joint capsule and extensor fascia, 50
cases of meniscus injury (Figure 1), 230 cases of posterior
cruciate ligament rupture, 300 cases of patellar tendon partial
rupture (1/3).

Figure 1: Schematic diagram of meniscus injury.

Surgical treatment

Knee arthroscopy search: The main equipment used for
arthroscopy search was Dyonics 700 single-chip camera
system (Smith&Nephew, Inc. London, Britain) (4.0 mm in
diameter, with 30-degree bevel wide-angle endoscopy). After
clear examination of complete anterior cruciate ligament
rupture, take anteromedial oblique mouth about 10 cm in
length from adductor tubercle to lower part of tubercle of tibia,
then cut out bone-patellar tendon-bone complex (tibia lateral
bone is 2.5 cm in length, 1.0 cm in thickness, patella lateral
bone is 2.0 cm in length, 0.6 to 0.8 cm in thickness, whose
width should be consistent with that of patellar tendon) after
reveal of patellar tendon to reconstruct anterior cruciate
ligament after finishing [12].

Extra articular injury treatment: Perform varus operation
under thirty degrees of knee flexion. Enter inside of structural
knee along the original incision, and search extent of medial
capsule and extensor knee damage and medial collateral
ligament rupture site. Suture lacerated joint capsule, then
suture extensor fascia. In situ suture repair can be performed
for medial collateral ligament stop point and somatic part
rupture. Lower dead point reconstruction is needed for
complete rupture of lower dead point. Drill bone tunnel at the
stop point, and fix the broken ends in the interior [14]. Place
negative pressure drainage tube under deep fascia of incision,
and suture patellar tendon defect and incision. Support plaster
after thirty degrees of knee flexion, and make good fixing
treatment.

Postoperative rehabilitation instruction and training
methods

Supine guidance: Nurses instruct patients to take the right
supine position and place according to good limb position to
prevent and reduce spasm and effectively protect patient's
shoulder. Patients’ upper extremity should stretch, while the
lower limb should take flexed position, with recumbent
position regularly changed to prevent poor blood flow, elbow
flexion, foot drop, etc.

Clinicians, nurses and rehabilitation therapists should
strengthen exchanges and communication, to determine
rehabilitation therapeutic regimen according to clinical
recovery of patient. After the therapeutic regimen is
determined, clinical nurses should inform patients and their
families of role and value of rehabilitation gymnastics with
professional knowledge, patiently explain the role of each
action for clinical rehabilitation, so as to mobilize patients and
their families.

Design of rehabilitation gymnastics: Rehabilitation
gymnastics is to exercise patients’ limb function, so as to
promote rehabilitation of neurological function. Design
principles of rehabilitation gymnastics should adhere to
soothing rhythm, appropriate exercise amount and action easy
to remember. According to patients’ rehabilitation phase, there
are neurological rehabilitation gymnastics on bed and standing
neurological rehabilitation gymnastics. There are six cycles in
neurological rehabilitation gymnastics on bed, namely, neck
movement, upper limb movement, waist and torso movement,
lower limb movement, hip movement, toes movement.
Rehabilitation gymnastics on bed should be done two to three
times a day, and 30 minutes per time is appropriate [16]; action
should be slow and place, avoid rush for quick results. There
are seven cycles in standing neurological rehabilitation
gymnastics, namely, shoulder movement, hand movement, arm
flexion movement, finger movement, flexion of the knee, leg
movement, facial exercise and massage. Standing rehabilitation
gymnastics should be done twice in the morning and evening,
with activity time controlled in about 30 min; activity time
should be adjusted according to recovery of patient, and
principle of gradual and orderly progress should be followed
[17].

Results

During 2006 and 2015, 3000 cases of patients with acute
complete anterior cruciate ligament rupture and medial
collateral ligament rupture were treated with an average
follow-up of 1 year. Patients have good rehabilitation recently,
all of whom restore normal motor function.

Discussion

After following up for one year, we found that incision healed
well and no infection was found and the patient recovered well
after operation. Knee anterior cruciate ligament rupture is a
common sports injury with very serious trauma. If not treated
timely or appropriately, it will lead to anterior cruciate
ligament knee deficiency, causing functional instability and a
series of sequelae lesions, which severely affects patient's knee
function and brings a lot of adverse effects to patient's daily
life [18]. Knee structure and injury mechanism have obvious
complexity. While resulting in anterior cruciate ligament
rupture, serious injury is often also combined with damage to
other structures. These injuries are mostly acute injuries,
mainly including joint swelling and pain, blood clots, muscle
cramps, interlocking muscle, etc. These factors also cause
impact on the test results, affect diagnosis accuracy, and delay
the best time for treatment. Although drawer test and Lachman
test are important methods to examine anterior cruciate
ligament injury, acute injury will significantly increase
examination difficulty. Research data indicate that lowest
preoperative positive rate is generally controlled within
twenty-four percent, but positive rate under anesthesia is only
60%.

In the treatment of patients with old ACL injury, the proportion
of secondary meniscus, articular cartilage injury and traumatic arthritis increased significantly, which had a serious adverse
effect on functional recovery. But early treatment and even
emergency surgical treatment can immediately clear and timely
treatment of combined injuries may exist within the joint, to
avoid secondary articular cartilage and meniscus injury caused
by delayed treatment, to minimize the occurrence of traumatic
arthritis. With early arthroscopic treatment for acute complete
anterior cruciate ligament injury, incidence of complications is
low. If endoscopic anterior cruciate ligament reconstruction is
required, operation time will be extended. In the meantime,
great importance should be attached to seepage of intraarticular
fluid to the crus which causes swelling. If such cases
occur, endoscopic surgery should be immediately stopped to
reduce incidence of complications and improve therapeutic
safety and reliability [19]. After intra-articular lesions clear and
corresponding endoscopic treatment can make early
rehabilitation training more targeted guidance, avoid intraarticular
injury is unknown and simple non operative
treatment, excessive or long-term restrictions of knee joint
activities, resulting in delayed recovery of joint function and
even joint stiffness and other adverse consequences, conducive
to the early rehabilitation of patients.